ObjectiveTo explore risk factors of blood transfusion during liver transplantation and construct its prediction model. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. ResultsA total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. ConclusionsResults of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.
ObjectiveTo systematically summarize the research progress in risk prediction models for postoperative anastomotic leakage in gastric cancer, and to explore the advantages and limitations of models constructed using traditional statistical methods and machine learning, thereby providing a theoretical basis for clinical precision prediction and early intervention. MethodBy analyzing domestic and international literature, the construction strategies of logistic regression, least absolute shrinkage and selection operator (LASSO) regression, and machine learning models (support vector machine, random forest, deep learning) were systematically reviewed, and their predictive performance and clinical applicability were compared. ResultsThe traditional logistic regression and LASSO regression models performed excellently in terms of interpretability and in small-sample scenarios but were limited by linear assumptions. The machine learning models significantly enhanced predictive capabilities for complex data through non-linear modeling and automatic feature extraction, but required larger data scales and had higher demands for interpretability. ConclusionsDifferent prediction models have their own advantages and limitations; in practical clinical applications, they should be flexibly selected or complementarily applied based on specific scenarios. Current anastomotic leakage prediction models are evolving from single factor analysis to multi-modal dynamic integration. Future efforts should combine artificial intelligence and multi-center prospective clinical studies to validate, so advancing the development of precise and individualized anastomotic leakage predictive tools for patients after gastric cancer resection.
Objective To analyze the correlation between HLA-A and B genotypes and maculopapular exanthema (MPE) caused by Carbamazepine (CBZ) and Oxcarbazepine (OXC), and to explore the genetic risk factors of MPE. Methods Patients with MPE (rash group) and patients without MPE (non-rash group) after taking CBZ or OXC were retrospectively collected from January 2016 to October 2021 in the Second Affiliated Hospital of Guangzhou Medical University. DNA was extracted from peripheral blood. HLA-A and HLA-B alleles were sequenced by high resolution sequencing, and a case-control study was conducted to analysis the correlations between MPE and HLA genotypes. Results A total of 100 patients with CBZ-MPE, 100 patients with CBZ-tolerant, 50 patients with OXC-MPE, and 50 patients with OXC-tolerant were collected. There was no significant difference in age and sex between CBZ, OXC rash groups and non-rash groups The average latency of CBZ-rash group was (11.31±11.00) days and their average dosage was (348.46±174.10) mg; the average latency of OXC-rash group was (11.67±10.34) days and their average dosage was (433.52±209.22) mg [equivalent to CBZ (289.01±139.48 mg)], showing no significant difference in latency and dosage between CBZ and OXC (P>0.05). The positive rates of HLA-A*24:02 and A*30:01 in CBZ-rash group were 28% and 6%, respectively, which were significantly higher than those in CBZ-non rash group (16% and 0%, both P=0.04). The positive rate of HLA-B*40:01 in CBZ-rash group was 18%, which was significantly lower than that in CBZ-non rash group (40%, P<0.001). No association between HLA-A or B genotype and OXC-rash was found yet. When pooled, it was still found that the positive rates of HLA-A*24:02 and A*30:01 in the rash group were higher than those in the non-rash group, while the positive rate of HLA-B*40:01 in the rash group was lower than that in the non-rash group, and the difference was statistically significant (P<0.05). Conclusions HLA-A*24:02 and A*30:01 were associated with MPE caused by CBZ, and may be common risk factors for aromatic antiepileptic drugs.
ObjectiveTo explore the relation between preoperative serum gamma-glutamyl transpeptidase to platelet ratio (GPR) and overall survival (OS) of patients with hepatitis B virus-associated hepatocellular carcinoma (Abbreviated as “patients with HCC”), and to establish a nomogram for predicting OS. MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients with HCC who underwent radical resection in the Department of Hepatobiliary Surgery of Xianyang Central Hospital, from January 15, 2012 to December 15, 2018, were retrospectively analyzed. The optimal critical value of GPR was determined by receiver operating characteristic curve, then the patients were divided into a low GPR group (GPR was optimal critical value or less ) and high GPR group (GPR was more optimal critical value). The Kaplan-Meier method was used to draw the survival curve and analyze the OS of patients. The univariate and multivariate Cox proportional hazards regression model were used to analyze the factors influencing prognosis in the patients with HCC. According to the risk factors of OS for patients with HCC, a nomogram was established. The consistency index and calibration curve in predicting the 3-year and 5-year accumulative OS rates of patients with HCC were evaluated. ResultsA total of 213 patients were gathered. The optimal critical value of GPR was 0.906. There were 114 patients in the low GPR group and 99 patients in the high GPR group. The Kaplan-Meier survival curve analysis showed that the 1-, 3- and 5-year accumulative OS rates were 99.1%, 81.8%, 60.6% in the low GPR group, respectively, which were 74.2%, 49.1%, 35.7% in the low GPR group, respectively. The OS curve of the low GPR group was better than that of the high GPR group (χ2=25.893, P<0.001). The multivariate analysis results showed that the microvascular invasion, incomplete capsule, intraoperative bleeding ＞1 000 mL, postoperative complications, GPR >0.906, low tumor differentiation, and late TNM stage did not contribute to accumulative OS in the patients with HCC (P<0.05). The consistency index (95%CI) of the nomogram in predicting accumulative OS rates at 3- and 5-year for patients with HCC were 0.761 (0.739, 0.783) and 0.735 (0.702, 0.838), respectively. The calibration curves of 3- and 5-year accumulative OS rates of the nomogram were in good agreement with the actual results. ConclusionsPreoperative GPR is associated with OS, and patients with higher GPR have worse prognosis. The nomogram based on GPR has a good accuracy and differentiation.
Objective To investigate the risk factors for end-stage liver disease (ESLD) complicated with fungal esophagitis (FE). Methods The clinical data of ESLD patients who underwent gastroscopy during their hospitalization in the Second Affiliated Hospital of Chongqing Medical University between January 1, 2017 and December 31, 2023 were retrospectively analyzed. The ESLD patients with FE were selected as the study group, and the ESLD patients without FE during the same period were included as the control group by 1∶2 propensity score matching method. Multivariate logistic regression model was used to analyze the risk factors of ESLD complicated with FE. Results A total of 75 ESLD patients with FE and 150 ESLD patients without FE were enrolled. There was no significant difference in age, gender, decompensated cirrhosis, liver cancer, diabetes mellitus, or etiology of ESLD between the two groups (P>0.05). Multivariate logistic regression analysis showed that longer hospital stay [odds ratio (OR)=1.115, 95% confidence interval (CI) (1.069, 1.164)], with invasive procedures [OR=10.820, 95%CI (4.393, 26.647)], and higher total bilirubin [OR=1.015, 95%CI (1.005, 1.024)] were risk factors for ESLD complicated with FE (P<0.05). In the study group, 41 patients were treated with antifungal drugs, and 4 of them developed invasive fungal infection. Among the 34 patients who did not receive antifungal drugs, 10 developed invasive fungal infection. Conclusions ESLD patients with longer hospital stay, worse liver function, and invasive procedures are more likely to develop FE, and regular gastroscopy should be performed. Once FE is found, active antifungal treatment should be taken to reduce the occurrence of invasive fungal infection and improve the prognosis of patients.
Objective To analyze the burden and trend of stroke attributable to metabolic risk factors in China from 1990 to 2021. Methods Data on deaths and disability-adjusted life years (DALYs) attributed to metabolic risk factors for stroke were analyzed based on the Global Burden of Disease (GBD) database 2021 in China, globally, and across different socio-demographic index (SDI) regions from 1990 to 2021. Joinpoint regression analysis was utilized to calculate the average annual percent change (AAPC) to evaluate temporal trends in disease burden. Results In 2021, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of stroke attributable to metabolic risk factors in China were 93.57/100 000 and 1 793.16/100 000, respectively, both higher than global and all SDI regional averages. Among metabolic-related stroke subtypes, ischemic stroke accounted for the highest disease burden, whereas subarachnoid hemorrhage had the lowest. Disease burden was greater in men compared with women. Both stroke mortality and DALYs rate increased with advancing age, with DALYs rate slightly declined only after the age of 95 years. Elevated systolic blood pressure (SBP) was identified as the leading metabolic risk factors for stroke burden. Between 1990 and 2021, the ASMR (AAPC=−1.34) and ASDR (AAPC=−1.38) attributed to metabolic risk factors of stroke in China showed decreasing trends, consistent with global and regional SDI averages, with greater reductions observed in women. Declining trends were also observed across all stroke subtypes, only stroke burden associated with high body mass index (BMI) exhibited an increasing trend. By 2031, the ASMR and ASDR are projected to decrease to 77.37/100 000 and 1 478.88/100 000, respectively. Conclusion From 1990 to 2021, the burden of stroke attributable to metabolic risk factors in China showed an overall declining trend. However, the burden remained higher compared with global and regions SDI levels, particularly among men and older adults. Future efforts should focus on enhancing metabolic factors screening and management in high-risk populations, along with optimizing individualized interventions to further reduce stroke burden.
Objective To investigate the risk factors for lymph node metastasis in cT1N0M0 stage squamous cell lung cancer and develop a logistic regression model to predict lymph node metastasis. Methods A retrospective study was conducted on patients with cT1N0M0 stage lung squamous cell carcinoma in our department from August 2017 to October 2022. The correlation between basic clinical data, imaging data, and pathological data and lymph node metastasis was analyzed. Univariate and multivariate logistic regression analyses were employed for risk factor analysis. Receiver operating characteristic curves and the Hosmer-Lemeshow test were utilized to evaluate the model’s discrimination and calibration. The Bootstrap method with 1 000 resamples was employed for internal validation of the model. Results Tumor location of central-type, tumor differentiation, cytokeratin 19 fragment (CYFRA21-1) levels, and tumor size were independent risk factors for lymph node metastasis in cT1N0M0 stage squamous cell lung cancer. The optimal cutoff values for tumor size and CYFRA21-1 levels were determined to be 2.05 cm and 4.20 ng/mL, respectively. The combination of tumor location, CYFRA21-1 levels, and tumor size demonstrates superior predictive capability compared to any individual factor. Conclusion Tumor location of central-type, poorly differentiated tumors, CYFRA21-1 levels, and tumor size are risk factors for lymph node metastasis in cT1N0M0 stage lung squamous cell carcinoma. The combined predictive model has certain guiding significance for intraoperative lymph node resection strategies in cT1N0M0 stage lung squamous cell carcinoma.
Objective To analyze and summarize the clinical characteristics of foreign body incarceration in upper digestive tract, and to explore the risk factors of its complications. Methods The clinical data of patients with foreign bodies in the upper digestive tract treated in the Affiliated Hospital of Zunyi Medical University between January 1, 2012 and December 31, 2021 were retrospectively analyzed, including demographic data, foreign body type, incarceration site, incarceration time, causes, symptoms, treatment methods and complications of foreign body incarceration. Logistic regression analysis was used to explore the risk factors of complications. Results A total of 721 patients were finally included, ranging in age from 3 months to 90 years old, with an average age of 26.76 years. The proportion of foreign bodies in the upper digestive tract in patients ≤14 years old was the highest (51.18%), and the duration of foreign body incarceration<12 hours was the highest (55.34%). The most common sharp foreign bodies in the upper digestive tract were animal bones (228 cases), and the most common round shaped foreign bodies were coins (223 cases). The most common impaction site was the upper esophageal segment (85.02%). 105 patients (14.56%) had complications, and perforation was the most common (5.55%). Logistic regression analysis showed that age [odds ratio (OR)=0.523, 95% confidence interval (CI) (0.312, 0.875), P=0.014], foreign body type [OR=0.520, 95%CI (0.330, 0.820), P=0.005], incarceration site [OR=2.347, 95%CI (1.396, 3.947), P=0.001], incarceration time [OR=0.464, 95%CI (0.293, 0.736), P=0.001] were the influencing factors of complications. Conclusions The majority of foreign bodies in the upper digestive tract are animal bones. The incidence of complications increase in patients with age ≥ 60 years, sharp foreign body edges, incarceration in the upper segment of the esophagus, and long incarceration time. It is recommended to remove the sharp foreign bodies incarcerated in the upper segment of the esophagus from the elderly as soon as possible.
ObjectiveTo analyze the prevalence and risk factors of metabolic syndrome (MS) after adult liver transplantation (LT) recipients. MethodsThe clinicopathologic data of patients with survival time ≥1 year underwent LT in the People’s Hospital of Zhongshan City from January 1, 2015 to August 31, 2020 were analyzed retrospectively. The logistic regression model was used to analyze the risk factors affecting MS occurrence after LT, and the receiver operating characteristic (ROC) curve was used to evaluate the optimal cutoff value of the index of predicting MS occurrence and its corresponding evaluation effect. ResultsA total of 107 patients who met the inclusion criteria were collected in this study. Based on the diagnostic criteria of MS of Chinese Medical Association Diabetes Association, the occurrence rate of MS after LT was 32.7% (35/107). Multivariate logistic regression analysis showed that the increased age of the recipient [OR (95%CI)=1.106 (1.020, 1.199), P=0.014], preoperative increased body mass index [OR (95%CI)=1.439 (1.106, 1.872), P=0.007] and blood glucose level [OR (95%CI)=1.708 (1.317, 2.213), P<0.001], and with preoperative smoking history [OR (95%CI)=5.814 (1.640, 20.610), P=0.006] and drinking history [OR (95%CI)=5.390 (1.454, 19.984), P=0.012] increased the probability of MS after LT. The areas under the ROC curve (AUC) corresponding to these five indexes were 0.666, 0.669, 0.769, 0.682, and 0.612, respectively. The corresponding optimal cutoff values of three continuous variables (recipient’s age, preoperative body mass index, and blood glucose level) were 53 years old, 23.1 kg/m2, and 6.8 mmol/L, respectively. The AUC of combination of the above five indexes in predicting occurrence of MS was 0.903 [95%CI (0.831, 0.952)], and the sensitivity and specificity were 80.0% and 90.3%, respectively. ConclusionsIncidence of MS after adult LT recipient is not low. For recipients with preoperative hyperglycemia, obese, elderly, histories of drinking and smoking before LT need to pay attention to the early detection and early intervention of MS.
ObjectiveTo investigate the current status of visual disability in people with opportunistic diabetes based on the physical examination center, and explore its related factors. MethodsPeople who went to West China Hospital of Sichuan University (West China Hospital district and Wenjiang hospital district) for physical examination between January 2019 and March 2020 were selected. The subjects were those who had a history of diabetes or fasting blood glucose≥7 mmol/L or glycosylated hemoglobin≥6.5%. They were divided into two groups according to visual acuity. The physical examinees with low vision were the observation group, and the physical examinees with normal vision were the control group (the number of cases was twice that of the observation group). The relevant data of the two groups were observed and compared, and the risk factors of low vision were analyzed by logistic regression. ResultsA total of 1 636 physical examinees with diabetes were included. There were 158 cases in the observation group and 316 cases in the control group. 158 cases (203 eyes) had low vision, and the incidence was 6.20% (203/3272). The main diseases leading to low vision were cataract (92 cases, 58.23%), high myopia (32 cases, 20.25%) and diabetes retinopathy (20 cases, 12.66%). Logistic regression analysis showed that the independent risk factors for low vision were age of diabetes patients, diabetes retinopathy, systolic blood pressure and glycosylated hemoglobin. ConclusionsThe incidence of low vision in diabetes population based on physical examination centers in Chengdu is low. Visual acuity examination should be strengthened for diabetes patients, especially the elderly, with diabetes retinopathy, high systolic blood pressure and glycosylated hemoglobin. Early effective prevention and treatment can reduce the damage to vision caused by diabetes.